Lymphocytic Infundibuloneurohypophysitis as a Cause of Central Diabetes Insipidus

Imura, Hiroo; Nakao, Kazuwa; Shimatsu, Akira; Ogawa, Yoshihiro; Sando, Takehiro; Fujisawa, Ichiro; Yamabe, Hirohiko

doi:10.1056/nejm199309023291002

Cited by 396 publications

(239 citation statements)

References 30 publications

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“…Lymphocytic infundibuloneurohypophysitis may also cause idiopathic diabetes insipidus, with lymphocytic infiltration of the pituitary stalk and destruction of the entire pituitary gland. 7) The histological features of this disease are similar to those in our case, although we consider our case as a separate entity because of the patient's age, lack of correlation with pregnancy, and paracavernous spread of the inflammation.…”

Section: Discussionsupporting

confidence: 75%

Granulomatous Pachymeningitis Around the Sella Turcica (Tolosa-Hunt Syndrome) Involving the Hypophysis-Case Report-

Kita

Tachibana

Nagai

et al. 2007

Neurol. Med. Chir.(Tokyo)

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A 50-year-old female presented with right painful abducens nerve palsy persisting for 4 months and mild panhypopituitarism with diabetes insipidus for 6 months. T 1 -weighted magnetic resonance (MR) imaging of the sellar region showed a homogeneously enhanced mass lesion in the right cavernous sinus which seemed to extend from the swollen pituitary gland. T 2 -weighted MR imaging clearly showed the mass in the right cavernous sinus and the thickened dura mater of the sellar floor as hypointense, and the enlarged pituitary gland as isointense. Biopsy of the thickened dura mater and swollen pituitary gland was performed via the transsphenoidal approach. Histological examination revealed inflammation and collagen fiber formation in these regions. The diagnosis was secondary panhypophysitis resulting from granulomatous pachymeningitis involving the cavernous sinus (Tolosa-Hunt syndrome). Corticosteroid therapy was begun after the biopsy. Her periorbital pain and diplopia were relieved, but diabetes insipidus persisted. Follow-up MR imaging showed a decrease in the volumes of the pituitary gland and the mass in the cavernous sinus.

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Section: Discussionsupporting

confidence: 75%

Granulomatous Pachymeningitis Around the Sella Turcica (Tolosa-Hunt Syndrome) Involving the Hypophysis-Case Report-

Kita

Tachibana

Nagai

et al. 2007

Neurol. Med. Chir.(Tokyo)

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“…Acquired central diabetes insipidus in childhood has a varied etiology including infiltrative mass (1), Langerhans cell histiocytosis (LCH) (2), and autoimmune and inflammatory diseases (3)(4)(5). The idiopathic forms appear to be the most common (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Evolution of childhood central diabetes insipidus into panhypopituitarism with a large hypothalamic mass: is 'lymphocytic infundibuloneurohypophysitis' in children a different entity?

Maghnie¹,

Genovese²,

Sommaruga³

et al. 1998

Eur J Endocrinol

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We report on a 15-year-old girl who had presented with acute onset central diabetes insipidus at the age of 8 years; this was followed by growth failure due to acquired growth hormone deficiency. Initial magnetic resonance imaging showed a uniformly enlarged pituitary stalk and absence of posterior pituitary hyperintensity. Frequent patient examination and magnetic resonance imaging gave unchanged results until after 5 years a large hypothalamic mass and panhypopituitarism were found. Dynamic magnetic resonance imaging documented hypothalamic-pituitary vasculopathy. Histopathological examination revealed perivascular inflammatory lymphoplasmic infiltrates with no granulomatosis or necrosis and negative staining for S-100 protein, suggesting autoimmuneinflammatory disease (lymphocytic infundibuloneurohypophysitis?). The response to glucocorticoid pulses (30 mg/kg per day for 3 days i.v.) was favorable, the hypothalamic mass being halved and partial anterior pituitary function recovery maintained for 2 years after the start of treatment. We suggest that long-term surveillance is needed for isolated and chronic thickening of the pituitary stalk and that dynamic magnetic resonance imaging can contribute to the demonstration of hypothalamic-pituitary vascular impairment associated with local vasculitis.

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“…Diffuse thickening of the pituitary stalk, enhanced contrast enhancement of the gland, and loss of the neurohypophyseal 'bright spot' can be seen on MRI (247,248). LyH can easily be mistaken for a pituitary adenoma and referred for surgery (249).…”

Section: Lymphocytic Hypophysitismentioning

confidence: 99%

Pregnancy and pituitary disorders

Karaca¹,

Tanrıverdi²,

Ünlühızarcı³

et al. 2010

European Journal of Endocrinology

164

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Major hormonal changes emerge during pregnancy. The pituitary gland is one of the most affected organs with altered anatomy and physiology. The pituitary gland is enlarged as a result of lactotroph hyperplasia. Due to physiological changes in the pituitary and target hormone levels, binding globulins, and placental hormones, hormonal evaluation becomes more complex in pregnant women. As a consequence of physiological hormonal changes, the evaluation of pituitary functions in pregnant women is quite different from that done in the prepregnant state. Pituitary adenomas may cause problems by their hormone secretion that affects the mother and the fetus besides causing an increased risk of tumor growth. Furthermore, diagnosis, course, and treatment of pituitary diseases point out differences. The changes in anatomy and physiology of the pituitary gland during pregnancy are reviewed. Pituitary disorders namely Cushing's disease; acromegaly; prolactinoma; TSH-secreting, gonadotropin-producing, and clinically nonfunctioning adenomas; craniopharyngioma; and Sheehan's syndrome, which is one of the most common causes of hypopituitarism, lymphocytic hypophysitis, and hypopituitarism, in relation to pregnancy are discussed. Being aware of all this information will prevent any serious problems which mother and child will be exposed to.

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Lymphocytic Infundibuloneurohypophysitis as a Cause of Central Diabetes Insipidus

Abstract: Diabetes insipidus can be caused by lymphocytic infundibuloneurohypophysitis, which can be detected by MRI. The natural course of the disorder is self-limited.

Cited by 396 publications

References 30 publications

Granulomatous Pachymeningitis Around the Sella Turcica (Tolosa-Hunt Syndrome) Involving the Hypophysis-Case Report-

Granulomatous Pachymeningitis Around the Sella Turcica (Tolosa-Hunt Syndrome) Involving the Hypophysis-Case Report-

Evolution of childhood central diabetes insipidus into panhypopituitarism with a large hypothalamic mass: is 'lymphocytic infundibuloneurohypophysitis' in children a different entity?

Pregnancy and pituitary disorders

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